Objective:To explore the early effects and safety of using a hybrid fixation strategy with 3D-printed porous tantalum metal augments to reconstruct substantial bone defects in complex primary total knee arthroplasty (TKA).Methods:A retrospective analysis was performed on the clinical data from August 2019 to September 2023, encompassing 20 patients (21 knees) with significant bone loss who underwent hybrid fixation with 3D-printed porous tantalum augments. The procedures were conducted at two medical centers: the First Affiliated Hospital, School of Medicine, Zhejiang University (11 cases) and Xiangya Hospital of Central South University (9 cases). The study cohort comprised 6 males (6 knees) and 14 females (15 knees), with a mean age of 61.05±11.23 years (range, 42-80 years). The distribution of cases was 7 on the left side and 14 on the right side. All cases were categorized as type 3 according to the Anderson Orthopaedic Research Institute (AORI) classification system. The cohort included 19 unilateral and 1 bilateral case, with 5 involving complex primary replacements (3 with Charcot arthropathy, 1 with syphilitic arthropathy, and 1 with severe valgus deformity) and 16 revision surgeries (13 for aseptic loosening and 3 for infection). Preoperative assessments included routine CT scans and digital three-dimensional reconstructions to identify large metaphyseal defects exceeding 50% of the metaphyseal area or those thicker than 10 mm. For such defects, 3D-printed standardized porous tantalum augments were implemented. In cases of extensive cavitary bone defects or severe metaphyseal defects where the medial and lateral defects collectively exceeded 80% of the metaphyseal region or where the residual bone stock was insufficient for screw fixation of standardized augments, 3D-printed personalized custom-made porous tantalum augments were employed for hybrid fixation and repair. Comparative analyses were conducted on pre- and postoperative imaging data (prosthesis positioning and complications), knee range of motion (ROM), visual analogue scale (VAS) for pain, and Knee Society score (KSS).Results:Of the cases, 17 were repaired using standardized 3D-printed porous tantalum augments, while 4 underwent repairs with customized augments for hybrid fixation. Follow-up averaged 26.5±15.0 months (range, 12-62 months). There was a significant increase in knee ROM, improving from 72.8°±31.9° preoperatively to 113.2°±6.8° at 12 months postoperatively ( P<0.05). VAS scores decreased from 6.6±1.4 preoperatively to 2.5±1.0 at 12 months postoperatively ( P<0.05). Similarly, KSS improved from 52.8±6.4 preoperatively to 80.7±7.9 at 12 months postoperatively ( P<0.05). There were no incidences of prosthesis displacement, poor bone integration, or postoperative infections. Conclusion:The hybrid fixation strategy employing 3D-printed porous tantalum augments has been found to be effective in addressing significant bone defects in TKA. The follow-up results indicate a satisfactory biological integration of the porous tantalum metal augments with the host bone, which has resulted in substantial improvements in pain relief and knee joint functionality.

Objective:To investigate the clinical characteristics of psoriasis and status quo of medical care for patients in county areas of China.Methods:This study was a cross-sectional investigation. Based on the “Qianxian Wuyin” Project (a national project for upgrating ability for psoriasis care at county level), an online questionnaire survey was conducted in the dermatology departments of 459 county hospitals in 404 pilot administrative counties across China from February to June 2023. The questionnaire included demographic information of patients (gender, ethnicity, age, place of residence, education, marital status), and clinical characteristics of psoriasis (disease course, type, comorbidities, body surface area (BSA) and previous treatment. The Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI) were applied for assessing the quality of life and disease severity, and completed by patients or guardian and doctors, respectively.Results:A total of 16 935 patients completed the questionnaire. The age of patients was 1-102(44.17±11.58)years, and 71.0% (12 036/16 935) were 30-59 years old. The ratio of male to female was 2.21∶1; 24.3%(4 117/16 935) of patients had high school education; there were 9 940 patients(58.7%) with previous or current smoking and/or alcohol use; 42.8%(7 218/16 855) of patients had a disease course of 1-5 years. There were 15 630 patients(92.3%) with DLQI≥10, 8 346 patients(49.7%) with PASI≥10, 15 017 patients(89.2%) with BSA≥10%. The plaque type was the most common disease type ( n=14 965, 88.7%), and spotting type ranked the second ( n=1 141, 6.8%). The most common initial site was the trunk ( n=12 309, 72.9%). Among the comorbidities, hypertension was the most common one ( n=1 681, 10.0%). There were 7 650 reports of treatment response to conventional topical drug therapy and 3 112 reports of treatment response to systemic drug therapy, with 6 269 (81.9%) and 2 493 (80.1%) reporting poor or no response, respectively. Conclusions:The survey shows that in the county areas of China, the majority of psoriasis patients are severe patients with short course of disease, plaque type is the most common type, and hypertension is the most common comorbidity; and the conventional treatment is less effective for most patients.

【Objective】 To analyze the risk factors of postpartum stress urinary incontinence (SUI) and to establish a nomogram model. 【Methods】 A total of 278 puerpera who gave birth at our hospital during Dec.2018 and Aug.2020 were selected as the modeling group, and 132 puerpera who gave birth during Sep.2020 and Sep.2021 were involved in the verification group. Factors affecting postpartum SUI were identified with univariate and multivariate logistic regression, and a nomogram prediction model was constructed with R software. The predictive effectiveness and discrimination of the model were assessed, and the decision curve analysis (DCA) was drawn to evaluate the clinical application value of the model. 【Results】 A total of 84 cases (30.22%) in the modeling group developed SUI 2 months after delivery. Fetal weight, delivery method, maternal age, mobility (Δhy) and rotation Angle (Δβ) were factors affecting postpartum SUI (P<0.05). Multivariate logistic regression analysis showed that increased fetal weight, normal delivery, increased Δhy, and increased Δβ were independent risk factors of postpartum SUI (P<0.05). The constructed nomogram fitted well. The H-L fit curve of the modeling group and verification group were (χ²=7.514, P=0.312) and (χ²=6.157, P=0.267), respectively. The area under the receiver operating characteristic curve of the modeling group and verification group were 0.815 and 0.760, respectively, indicating high specificity and consistency. DCA indicated that when the high-risk threshold probability of the model was between 0.06-0.80, the nomogram model had a high clinical value. 【Conclusion】 Increased fetal weight, normal delivery, increased Δhy and elevated Δβ are independent risk factors that affect postpartum SUI. The nomogram model constructed has good predictive effectiveness and discrimination, and high clinical application value.

Humans ; Femoral Artery/surgery* ; Hip Dislocation, Congenital ; Hip Joint ; Treatment Outcome

Objective:To explore the prevalence of passenger lymphocyte syndrome(PLS) after liver transplantation, minimize the result bias caused by previous multicenter confounding factors, make up for the lack of statistical analysis of PLS and provide reference for a diagnosis and treatment of PLS after liver transplantation.Methods:We reviewed liver transplants performed in our center from 2018 to 2019, searching for cases with minor ABO incompatibility or bidirectional ABO incompatibility. Diagnostic criteria for PLS: laboratory confirmation included biochemical identifiers of hemolysis, positivity of the direct antiglobul in test(DAT), donor attributed anti-recipient antibody in recipient's sera, and exclusion of other causes of decreased HGB(i.e. postoperative infection, acute rejection & surgical blood loss). A total of 666 liver transplants were performed. Among 52 patients with minor ABO incompatibility or bidirectional ABO incompatibility, 10 cases developed PLS(19.23%)and 42 cases did not(80.77%). Statistical comparisons between patients with and without PLS were performed using the chi-square test and Fisher's exact test.Results:There were no statistically significant differences in PLS group subjects in terms of sex, age, blood group, type of incompatibility, type of immunosuppressants and postoperative outcome. There was statistically significant correlation between postoperative blood transfusion and PLS( P< 0.05), and donor blood group B cohort demonstrated a higher risk of PLS than donor blood group A and O cohorts( P< 0.05). Conclusions:PLS is one of the causes for postoperative anemia in liver transplantation, and donor blood group B graft is a risk factor for PLS.

OBJECTIVE: To analyze serological and molecular characteristics of a case with Bw11 subtype. METHODS: The ABO antigen and antibody in serum were respectively detected with the classical tube method, microcolumn gel method, and absorption and diffusion method. The ABO genotype was determined with PCR using sequence-specific primers (PCR-SSP). Exons 1-7 of the ABO gene were analyzed by Sanger sequencing. Haplotype analysis was carried out for exons harboring variants. RESULTS: Forward and reverse typing with the microcolumn gel method has suggested type O, while forward and reverse typing with the classical tube method yielded inconsistent results. Absorption and diffusion test confirmed presence of B antigen. Antibody screening excluded presence of alloantibodies. The result of PCR-SSP suggested a B/O1 genotype.A 695T>C variant was identified in exon 7 as compared with the B101/O01 allele, which resulted in conversion of Leucine to Proline at position 232, and was confirmed as Bw11/O1 heterozygote. CONCLUSION The nt695T>C variant probably underlay the weakening of B antigenin the individual. There may be strong anti-B antibodies in Bw11 subtypes. Human-derived and certain monoclonal reagents may not detect Bw11 subtypes which is easy to be misjudged as type O. Application of molecular methods can identify ABO subtypes with accuracy.

Objective: To investigate the sex- and age-specific association between resting heart rate and hypertension in rural adult residents of Henan province. Methods: At baseline, a total of 20 194 participants were randomly selected from Xin′an County of Henan province between July 2007 and August 2008. After excluding participants with hypertension or without resting heart rate data at baseline, and participants died or without hypertension outcome or diagnosed as gestational hypertension during follow-up between July 2013 and October 2014, 10 212 participants were finally included in this study. Multiple linear regression model was used to examine the association between resting heart rate and change of blood pressure. Logistic regression model was used to estimate the association between resting heart rate and risk of hypertension. Results: There were 2 059 new hypertensive cases (839 male) during the 6 years follow-up. After controlling for potential confounders, per 5 beats/minutes increases in resting heart rate was associated with 0.18 mmHg (1 mmHg=0.133 kPa) (95%CI 0.01-0.36 mmHg, P=0.046) absolute increase in systolic blood pressure and 7% higher risk of developing hypertension in women (95%CI 1.03-1.11, P<0.05). Compared with resting heart rate<70 beats/minutes, the adjusted RRs for 76-82 and>82 beats/minutes groups were 1.39 (95%CI 1.18-1.63, P<0.05) and 1.22 (95%CI 1.02-1.45, P<0.05), respectively. For both age groups, increased resting heart rate was positively associated with risk of hypertension in women(RR=1.05(95% CI 1.01-1.10), P<0.05 (the women those <60 years); RR=1.14(95% CI 1.04-1.25), P<0.05 (the women those≥60 years). However, no significant association was found between resting heart rate and hypertension in male residents. Conclusions Increased resting heart rate is associated with high risk of hypertension in women who live in rural area, especially in elder women of this cohort.

Objective: To investigate the sex- and age-specific association between resting heart rate and hypertension in rural adult residents of Henan province. Methods: At baseline, a total of 20 194 participants were randomly selected from Xin'an County of Henan province between July 2007 and August 2008. After excluding participants with hypertension or without resting heart rate data at baseline, and participants died or without hypertension outcome or diagnosed as gestational hypertension during follow-up between July 2013 and October 2014, 10 212 participants were finally included in this study. Multiple linear regression model was used to examine the association between resting heart rate and change of blood pressure. Logistic regression model was used to estimate the association between resting heart rate and risk of hypertension. Results: There were 2 059 new hypertensive cases (839 male) during the 6 years follow-up. After controlling for potential confounders, per 5 beats/minutes increases in resting heart rate was associated with 0.18 mmHg (1 mmHg=0.133 kPa) (95%CI 0.01-0.36 mmHg, P=0.046) absolute increase in systolic blood pressure and 7% higher risk of developing hypertension in women (95%CI 1.03-1.11, P<0.05). Compared with resting heart rate<70 beats/minutes, the adjusted RRs for 76-82 and>82 beats/minutes groups were 1.39 (95%CI 1.18-1.63, P<0.05) and 1.22 (95%CI 1.02-1.45, P<0.05), respectively. For both age groups, increased resting heart rate was positively associated with risk of hypertension in women(RR=1.05(95% CI 1.01-1.10), P<0.05 (the women those <60 years); RR=1.14(95% CI 1.04-1.25), P<0.05 (the women those≥60 years). However, no significant association was found between resting heart rate and hypertension in male residents. Conclusions: Increased resting heart rate is associated with high risk of hypertension in women who live in rural area, especially in elder women of this cohort.
Adult ; Blood Pressure ; Cohort Studies ; Female ; Heart Rate ; Humans ; Hypertension ; Male ; Risk Factors ; Rural Population

Objective:To study the clinical course and underlying causes of early severe neurological complication (ESNC) after pediatric liver transplantation.Methods:A retrospective study was conducted on 309 pediatric liver transplantation recipients treated at Tianjin First Central Hospital from January 2018 to December 2018. ESNC occurred in 15 patients (4.8%, 15/309) within 1 month after liver transplantation. There were 7 males and 8 females, aged from 6 to 46 months. Liver transplantation was carried out for biliary atresia ( n=12), fulminant liver failure ( n=1), Niemann-Pick disease ( n=1) and Alagille syndrome ( n=1). The causes of ESNC and the prognosis were analyzed. Results:The onset of ESNC was 10.7 (0-28) d after liver transplantation. Twelve patients developed encephalopathy with epilepsy in 2 patients. Four of these patients were caused by severe infection, 4 by heart failure combined with respiratory failure which led to ischemic hypoxic encephalopathy, 2 by transplant liver failure, 1 by intracranial infection, and 1 by severe brain swelling which led to brain death. Epilepsy occurred in 3 patients, 2 caused by neurotoxicity of calcineurin inhibitors, and 1 caused by reversible posterior leukoencephalopathy syndrome. Three children with ESNC died after operation, including 1 brain death, 1 due to severe heart failure and 1 due to severe infection.Conclusions:ESNC occurred in 4.8% of patients which seriously affected long-term prognosis of patients. Measures to reduce the incidence of ESNC include prevention of postoperative infection and drug toxicity, and good control of cardiac insufficiency.

Objective: Constructing and applying the multi-module training program for junior midwives to improve the training quality. Methods: The training program was constructed according to different modules of core competence. 11 junior midwives were selected from a hospital in Zhengzhou as trainees. The training effect was evaluated. Results: Their core competence has been enhanced in theory knowledge, operating skills and training satisfaction (P < 0.05). After training, the rate of episiotomy and the rate of postpartum hemorrhage were lower than before (P<0.05). Conclusion The multi-module training program can improve the core competence of junior midwives, which provides effective training method and promotes the quality of training.